Heparin and citrate additive carryover during blood collection.
Anticoagulants
Blood Coagulation
/ drug effects
Blood Coagulation Tests
/ methods
Blood Specimen Collection
/ methods
Citrates
Citric Acid
/ analysis
Equipment Contamination
/ prevention & control
Heparin
/ analysis
Humans
Partial Thromboplastin Time
Phlebotomy
/ methods
Pre-Analytical Phase
/ methods
Prothrombin Time
Thrombin Time
blood sampling
order of draw
preanalytical phase
sample handling
specimen handling
Journal
Clinical chemistry and laboratory medicine
ISSN: 1437-4331
Titre abrégé: Clin Chem Lab Med
Pays: Germany
ID NLM: 9806306
Informations de publication
Date de publication:
26 Nov 2019
26 Nov 2019
Historique:
received:
24
04
2019
accepted:
11
07
2019
pubmed:
5
8
2019
medline:
18
9
2020
entrez:
5
8
2019
Statut:
ppublish
Résumé
Background Published evidence on the risk of additive carryover during phlebotomy remains elusive. We aimed to assess potential carryover of citrated and heparinized blood and the relative volume needed to bias clinical chemistry and coagulation tests. Methods We simulated standardized phlebotomies to quantify the risk of carryover of citrate and heparin additives in distilled water, using sodium and lithium as surrogates. We also investigated the effects of contamination of heparinized blood samples with increasing volumes of citrated blood and pure citrate on measurements of sodium, potassium, chloride, magnesium, total and ionized calcium and phosphate. Likewise, we studied the effects of contamination of citrated blood samples with increasing volumes of heparinized blood on heparin (anti-Xa) activity, lithium, activated partial thromboplastin time (APTT), prothrombin time (PT) and thrombin time (TT). We interpreted these results based on measurement deviations beyond analytical, biological and clinical significance. Results Standardized phlebotomy simulations revealed no significant differences in concentration of surrogate markers. Clinically significant alterations were observed after contamination of heparinized blood samples with volumes of citrated blood beyond 5-50 μL for ionized calcium and beyond 100-1000 μL for sodium, chloride and total calcium. Investigations of pure citrate carryover revealed similar results at somewhat lower volumes. Heparinized blood carryover showed clinically significant interference of coagulation testing at volumes beyond 5-100 μL. Conclusions Our results suggest that during a standardized phlebotomy, heparin or citrate contamination is highly unlikely. However, smaller volumes are sufficient to severely alter test results when deviating from phlebotomy guidelines.
Identifiants
pubmed: 31377734
doi: 10.1515/cclm-2019-0433
pii: cclm-2019-0433
doi:
Substances chimiques
Anticoagulants
0
Citrates
0
Citric Acid
2968PHW8QP
Heparin
9005-49-6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1888-1896Références
Rohr UP, Binder C, Dieterle T, Giusti F, Messina CG, Toerien E, et al. The value of in vitro diagnostic testing in medical practice: a status report. PLoS One 2016;11:e0149856.
Plebani M, Laposata M, Lundberg GD. The brain-to-brain loop concept for laboratory testing 40 years after its introduction. Am J Clin Pathol 2011;136:829–33.
Jafri L, Khan AH, Ghani F, Shakeel S, Raheem A, Siddiqui I. Error identification in a high-volume clinical chemistry laboratory: five-year experience. Scand J Clin Lab Invest 2015;75:296–300.
Cadamuro J. Internal quality assurance for preanalytical phase. In: Guder WG, Narayanan S, editors. Pre-examination procedures in laboratory diagnostics. Berlin: De Gruyter, 2015:345–51.
Calam RR, Cooper MH. Recommended “order of draw” for collecting blood specimens into additive-containing tubes. Clin Chem 1982;28:1399.
Cornes M, van Dongen-Lases E, Grankvist K, Ibarz M, Kristensen G, Lippi G, et al. Order of blood draw: Opinion Paper by the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase (WG-PRE). Clin Chem Lab Med 2017;55:27–31.
Simundic AM, Bolenius K, Cadamuro J, Church S, Cornes MP, van Dongen-Lases EC, et al. Joint EFLM-COLABIOCLI recommendation for venous blood sampling. Clin Chem Lab Med 2018;56:2015–38.
Sharratt CL, Gilbert CJ, Cornes MC, Ford C, Gama R. EDTA sample contamination is common and often undetected, putting patients at unnecessary risk of harm. Int J Clin Pract 2009;63:1259–62.
Sulaiman RA, Cornes MP, Whitehead SJ, Othonos N, Ford C, Gama R. Effect of order of draw of blood samples during phlebotomy on routine biochemistry results. J Clin Pathol 2011;64:1019–20.
Cornes MR, Sulaiman RA, Whitehead SJ, Othonos N, Ford C, Gama R. Incorrect order of draw of blood samples does not cause potassium EDTA sample contamination. Br J Biomed Sci 2012;69:136–8.
Cornes MP, Ford C, Gama R. The order of draw, myth or science. Clin Chem Lab Med 2013;51:e285.
Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Picheth G, Guidi GC. Incorrect order of draw could be mitigate the patient safety: a phlebotomy management case report. Biochem Med (Zagreb) 2013;23:218–23.
Salvagno G, Lima-Oliveira G, Brocco G, Danese E, Guidi GC, Lippi G. The order of draw: myth or science? Clin Chem Lab Med 2013:1–5.
Cadamuro J, Felder TK, Oberkofler H, Mrazek C, Wiedemann H, Haschke-Becher E. Relevance of EDTA carryover during blood collection. Clin Chem Lab Med 2015;53:1271–8.
Cornes MP, Ford C, Gama R. Undetected spurious hypernatraemia wastes health-care resources. Ann Clin Biochem 2011;48 (Pt 1):87–8.
Logie JJ, Chaloner C. A national survey of specimen contamination in the UK. Ann Clin Biochem 2019;56:219–27.
Indevuyst C, Schuermans W, Bailleul E, Meeus P. The order of draw: much ado about nothing? Int J Lab Hematol 2015;37:50–5.
Ricos C, Alvarez V, Cava F, Garcia-Lario JV, Hernandez A, Jimenez CV, et al. Current databases on biological variation: pros, cons and progress. Scand J Clin Lab Inv 1999;59:491–500.
Fraser CG. Reference change values. Clin Chem Lab Med 2012;50:807–12.
Berg JE, Ahee P, Berg JD. Variation in phlebotomy techniques in emergency medicine and the incidence of haemolysed samples. Ann Clin Biochem 2011;48(Pt 6):562–5.
Simundic AM, Church S, Cornes MP, Grankvist K, Lippi G, Nybo M, et al. Compliance of blood sampling procedures with the CLSI H3-A6 guidelines: an observational study by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PRE). Clin Chem Lab Med 2015;53:1321–31.
Cornes MP, Davidson F, Darwin L, Gay C, Redpath M, Waldron JL, et al. Multi-centre observational study of spurious hyperkalaemia due to EDTA contamination. Clin Lab 2010;56: 597–9.
Bouzid K, Bartkiz A, Bouzainne A, Cherif S, Ramdhani S, Zairi A, et al. How to reduce EDTA contamination in laboratory specimens: a Tunisian experience. Clin Chem Lab Med 2015;53:E9–12.
Boink AB, Buckley BM, Christiansen TF, Covington AK, Maas AH, Muller-Plathe O, et al. IFCC recommendation on sampling, transport and storage for the determination of the concentration of ionized calcium in whole blood, plasma and serum. J Automat Chem 1991;13:235–9.
Ceron JJ, Martinez-Subiela S, Hennemann C, Tecles F. The effects of different anticoagulants on routine canine plasma biochemistry. Vet J 2004;167:294–301.
Mohri M, Rezapoor H. Effects of heparin, citrate, and EDTA on plasma biochemistry of sheep: comparison with serum. Res Vet Sci 2009;86:111–4.
van den Besselaar AM, van Zanten AP, Brantjes HM, Elisen MG, van der Meer FJ, Poland DC, et al. Comparative study of blood collection tubes and thromboplastin reagents for correction of INR discrepancies: a proposal for maximum allowable magnesium contamination in sodium citrate anticoagulant solutions. Am J Clin Pathol 2012;138:248–54.
White G. Serum ethylenediaminetetraacetic acid concentrations in routine samples submitted for biochemical analysis. Ann Clin Biochem 2010;47(Pt 5):485–6.